How Close Are We to an HIV Cure?

Medically Reviewed by Zilpah Sheikh, MD on April 11, 2024
Written by Susan Bernstein
7 min read

Antiretroviral therapy (ART) can treat and control infection with HIV, the virus that causes AIDS. People who take these medications can reduce the amount of the virus in their bodies so much that blood tests don't even show it's there. They can live long, healthy lives. They're less likely to pass the virus to others.

But even if you take ART drugs as prescribed, an inactive form of the virus still lives in groups of cells in your body called HIV reservoirs. If you stop taking ART, the virus in the reservoirs can become active again and lead to AIDS. There's still no general cure for HIV infection, although a handful of people across the world have become HIV-free after having risky stem cell transplants to treat cancer.

You may see or hear claims that certain herbal medicines, devices, or chemicals can cure HIV. But no natural or alternative remedy can cure or effectively treat HIV. Some herbal medications can even keep antiretroviral drugs from working as they should. 

Although we've gone 40 years without a cure for HIV, scientists believe one is possible. They're researching several ways to make that happen.

 

Experts have a couple of visions of what a potential cure for HIV might look like:

Treatment-free remission means the virus is controlled without the need for ART drugs, which you now must take every day for life. Millions of people who have HIV can’t afford ART, and the treatment can sometimes cause serious side effects. So we need other options. 

You might hear treatment-free remission called a functional cure. It means that you:

  • Can expect to live a healthy life of normal length
  • Don't need to take ART or any other HIV-related drugs to keep the virus under control
  • Can't pass HIV to others

Scientists are studying many therapies to control HIV without the need for daily ART. These include antibody therapies and therapeutic vaccines. They don’t prevent infection, but stimulate your own immune system to fight it.

Another possibility is drugs that could make the inactive virus in the reservoirs stay that way for good, even if you stop ART.

Viral eradication, or eliminating all HIV in the body, is another way of looking at a potential cure. It’s also known as a sterilizing cure or complete cure. 

Scientists believe it would take a two-part treatment to completely wipe out HIV. The first part would involve drugs that make virus cells within the HIV reservoirs multiply and give off proteins that work like a signal to your immune system. The second part would include drugs that detect those protein signals, then seek out and kill the virus. You might hear this approach called "kick and kill."

Drugs that might be able to seek out and kill HIV include histone deacetylase (HDAC) inhibitors, protein kinase activators, latency securing agents, and immunotoxins. These drugs could be used together. Researchers are also testing a technique called gene editing that can insert an HIV-protective mutation (change) into your genes.

Can HIV be cured at an early stage?

In a handful of cases, people who started ART within a few weeks after infection but later stopped treatment ended up with undetectable levels of HIV. Researchers are studying these so-called post-treatment controllers to learn more about why their bodies seem to be able to control the virus after early treatment.

This probably isn't possible for most people. But scientists say that the earlier you get treatment, the smaller your reservoirs of HIV will be. Early treatment could also stop some HIV reservoirs from forming and help protect your immune system.

How far away is a cure for HIV?

It's impossible to say exactly when a cure for HIV might be available. The United Nations and many countries around the world have set a goal of ending the international HIV and AIDS epidemic by 2030. But this goal includes prevention strategies and better access to existing drugs as well as treatment research.

One reason to hope for a cure for HIV is that a few people seem to have been cured already. 

Six people infected with HIV had stem cell transplants to treat potentially fatal cases of blood cancer. Five of them were given stem cells from donors who have a rare inherited gene mutation that makes them resistant to HIV infection. Stem cells can develop into many different types of cells. Basically, all the cells in the transplant recipients' immune systems were replaced by these donor cells. 

After the transplants, all six were able to stop ART. They no longer have any signs of the virus, even years later.

While these cases show that a cure is possible, this technique isn't practical for widespread use. This type of transplant is pricey, it often doesn't work, and it has a high risk of complications. That's why it's only given to people with life-threatening cancers. It's also hard to find donors who have the protective genes. 

Elite controllers

Scientists are also looking for clues to a cure by studying the "elite controllers" who have the inherited trait that helps them resist infection. These people never get HIV symptoms although they don't have ART. Research has shown that a couple of them appear to no longer have the virus in their bodies at all. 

Gene therapy

All of these cases are part of the research into gene therapy for HIV. This is a promising area of study that involves changing a person's DNA. Gene therapy can involve:

  • "Editing out" certain genes from HIV that help it get into other cells. You'd still have the virus in your body, but it couldn't infect you or others.
  • Adding protective genes, like the ones elite controllers are born with, to your immune cells. This is the technique used in stem cell transplants. 
  • Removing genes from HIV that have become part of the cells infected with the virus. This uses technologies such as CRISPR that can target the HIV genes without harming the infected cells.

Immune system approaches

Another promising approach involves immunotherapy, a technique now used in cancer treatments that boosts your immune system to help it get rid of the virus. People infected with HIV, even those who get treatment, often have depleted immune systems.

Also, early research has shown that either an HIV vaccine or immune system proteins (antibodies) that specifically target HIV could help keep the virus in check without ART. But we need more and bigger studies into this.

mRNA technology

Researchers are looking at mRNA technology, the same type used in developing the COVID-19 vaccine, in the search for a cure. An mRNA molecule can instruct your cells to make proteins that trigger an immune response, which helps fight off the virus. Scientists are working on a way to send mRNA to immune system cells within HIV reservoirs. 

Finding a cure for HIV poses several challenges:

Perhaps the biggest one is HIV's ability to become inactive and hide in the reservoirs, which can be in places like your lymph nodes, gut, genital tract, and bone marrow. Neither existing treatments nor your immune system can detect or fight the virus when it's inactive. We don’t fully understand how HIV reservoirs work. Scientists are learning how to find, measure, and destroy them.

Another is the fact that HIV can change, or mutate, very quickly. This makes it very hard for your immune system or any vaccine to target. 

Yet another challenge is that HIV attacks the very T cells that your body uses to fight off infection and turns them into its breeding ground. This weakens your immune system and prevents it from fighting off the virus. It also means some types of vaccines could make HIV worse.

On a practical level, it's not easy to do HIV research, get funding for this research, or find people willing to take part in studies. Males are the subjects of most HIV clinical trials, but about half of people with the virus are female. We need more studies to look at whether treatments will work on women and girls. 

When a cure is developed, it will need to be widely available and affordable enough for widespread use across the globe. There are more HIV cases in Eastern and Southern Africa than anywhere else. Nearly half of all new HIV infections are in this region.

 

Reputable sources of information about HIV research include:

To find out about taking part a clinical trial, ask your doctor or visit the Office of AIDS Research website.

While you can effectively treat HIV with antiretroviral therapy, there's not yet a cure. Can HIV be cured? Researchers think so, though it's not clear when that might happen. They're studying several possible solutions, including vaccines, gene therapy, and immunotherapy. 

How long can HIV patients live?

Research has found that people with HIV have life expectancies similar to those without the virus if they:

  • Are diagnosed in a timely fashion
  • Get good medical care
  • Stick to the treatment their doctor recommends 

Can I live with HIV without medication?

Lifespans for those who have HIV but don't get treated can vary a lot from person to person. But once you have AIDS, life expectancy is about 3 years without treatment. 

Can you have HIV for 20 years and not know?

HIV may not cause any symptoms for several years. Most people are diagnosed 10-15 years after they're infected, but it can take longer. In a handful of cases, people have gotten infected but never developed symptoms even though they don't get ART. They're called elite controllers.